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Midwife-led care is cost-effective and safe in Ireland too!

The results of a financial analysis of the different types of care experienced by women in a randomised controlled trial carried out in Dublin, Ireland have shown that, for low-risk women, care in midwife-led units is more cost-effective than consultant-led care. “Given the clinical findings,” the authors write, “which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.” (Kenny et al 2015).

This study is a comparison of costs analysis conducted on the outcomes from the MidU study; a randomised controlled trial which compared two types of care for low-risk women. The results from the oiriginal MidU trial showed that there was no difference between the group of women who were randomised to receive midwife-led care and the group of women randomised to receive consultant-led care in most of the primary outcomes, including caesarean birth, induction of labour, episiotomy, instrumental birth, Apgar scores, postpartum haemorrhage, and breastfeeding initiation. There were differences between the groups in relation to the numbers of women who experienced continuous electronic fetal monitoring and augmentation of labour, however, with women randomised to the midwife-led group receiving less intervention overall.

The cost analysis, which has been published online ahead of print in the journal Midwifery, shows that midwife-led care is also financially superior to consultant-led care. The authors found that the average cost of caring for a woman allocated to the midwife-led units was €2,598, compared to €2,780 for a woman who was allocated to care in the consultant-led units.

“The ‘intention to treat’ analysis provided an overall estimate of the average cost of care of a woman in an MLU and found it to be €182 less than the average cost of care in the CLU. Given a throughput of 1,000 women per year in an MLU, the savings would be over €180,000 per year.” (Kenny et al 2015).

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